| NPI | 1750906814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000528) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401419394) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS 4464-24) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS OS-6067-24) | |
| Enumeration Date | 2020-06-14 |
| Last Update Date | 2025-07-02 |